ALERT HEALTHCARE & PHARMACEUTICALS - Cliffe Dekker Hofmeyr
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17 MAY 2021 HEALTHCARE & PHARMACEUTICALS ALERT IN THIS ISSUE > Telemedicine: Band-aid or long-term solution? COVID-19 highlighted the necessity of having a viable telemedicine regime as a ‘safety net’ to ensure continued access to healthcare services whilst maximising social distancing. We now have an opportunity to better understand the challenges and exploit the benefits of telemedicine services.
HEALTHCARE &
PHARMACEUTICALS
Telemedicine: Band-aid or
long-term solution?
COVID-19 highlighted the necessity of Regulation of telemedicine in
having a viable telemedicine regime as a South Africa
The aim of telemedicine ‘safety net’ to ensure continued access
COVID-19 necessitated a relaxation of
to healthcare services whilst maximising
is not to eradicate the rules governing telemedicine. As an
social distancing. We now have an
face-to-face consultations opportunity to better understand the
infection-control solution, telemedicine
helps reduce health care workers’
with healthcare challenges and exploit the benefits of
contact with patients, whilst enabling
workers, but to improve telemedicine services.
vulnerable groups to receive certain
accessibility and efficiency To do more with less, beyond the healthcare services during self-isolation.
of healthcare services. pandemic, innovative developments in Telemedicine in South Africa is regulated
technology can increase access to care in terms of, amongst others, the General
(where appropriate) and lower systemic Ethical Guidelines for Good Practices
costs, particularly for vulnerable groups in Telemedicine, issued by the Health
and those in underserviced rural areas, Professions Council of South Africa
where face-to-face care is not a viable or (HPCSA) in 2014 (2014 Guidelines).
efficient option.
The HPCSA is a statutory body overseeing
What is telemedicine? the education, training, and registration
of health professionals, aiming to among
Terms such as telehealth services,
other things, ensure that practitioners
digital health and e-health are often
maintain professional and ethical
used synonymously with telemedicine.
standards. Understandably, there is a
Examples include specialists exchanging
need to regulate healthcare practitioners’
a patient’s medical history via messaging
conduct, especially when dealing with
apps, telephonic or video consultations
patients remotely. Having certain checks
between patients and healthcare workers
and balances in place is desirable to
and remote monitoring of patients.
ensure that the process is not abused to
Telehealth is defined by the World Health the detriment of patients, for example,
Organisation (WHO) as the remote through over-servicing. Rules can help
delivery of healthcare services by all maintain standards and ensure that the
healthcare professionals, where distance quality and safety of patient care is not
is a defining factor, using information unnecessarily compromised.
and communication technology (ICT)
Under the HPCSA’s initial paradigm all
for the exchange of information for the
telemedicine services should involve a
diagnosis and treatment of diseases and
healthcare provider where there is an
injuries, research and evaluation, and
actual face-to-face consultation and
for the continuing education of health
physical examination of the patient
professionals.
in a clinical setting by a ‘consulting
The aim of telemedicine is not to eradicate practitioner’, who will communicate the
face-to-face consultations with healthcare information to the ‘servicing practitioner’
workers, but to improve accessibility and to provide the necessary assistance.
efficiency of healthcare services.
Accordingly, the 2014 Guidelines barred
first-time consultations between a patient
and healthcare worker and meant that only
telemedicine consultations facilitated by
2 | HEALTHCARE & PHARMACEUTICALS ALERT 17 May 2021HEALTHCARE &
PHARMACEUTICALS
Telemedicine: Band-aid or
long-term solution?...continued
one healthcare practitioner with another further announcements on the continued
healthcare practitioner (on behalf of use of this guidance after the pandemic
Telemedicine is frequently the patient) were allowed, with limited subsides. This presents an opportunity
exceptions if there was already an existing for expanding the responsible use of
judged against the relationship between the healthcare telehealth services.
counterfactual of worker and the patient.
One can expect businesses and
face-to-face care, where When the national lockdown commenced, practitioners which have invested in
it may fall short. In and only for the limited duration of technology to support telehealth during
South Africa, however, the the COVID-19 pandemic, the HPCSA the pandemic will likely resist a complete
lived experience of the minimally relaxed its stance by issuing reversal of the relaxations.
guidance which replaced the reference
counterfactual is often to “telemedicine” with “telehealth”, which
Benefits
no or less care due to definition now included telepsychology, Telemedicine is frequently judged against
access constraints. telepsychiatry, and telerehabilitation, the counterfactual of face-to-face care,
amongst others. The requirement for an where it may fall short. In South Africa,
already established practitioner-patient however, the lived experience of the
relationship remained, except for counterfactual is often no or less care due
telepsychology and telepsychiatry. Critics to access constraints. Telemedicine can
referred to a lack of clarity in respect of enable healthcare workers, particularly
the length of time and other requirements scarce specialists, to reach patients in
needed to “establish a relationship” remote and rural locations which they
between the patient and the physician. would not normally be able to access.
Despite the hard lockdown having Pre-pandemic, the National Department
commenced, the HPCSA specifically of Health, in its e-health strategy
advised against telephone and/or virtual (2012 – 2016) recognised the potential
consultations for new patients (HPCSA of telemedicine “as a tool that could
Guidance Note 26 March 2020). bridge the gap between rural health and
specialist services.”
This limited relaxation met resistance
from the medical fraternity, nudging the An additional important benefit is the
HPCSA to issue further amendments in role telemedicine can play in upskilling
order to allow first-time consultations health care workers, by using technology
between clinicians and patients without as a training tool; a huge gain in South
an established relationship, provided Africa where we face a healthcare human
such consultations are in the clinical resources crisis and an inequitable
best interest of patients. (HPCSA Notice geographic spread of available specialists,
3 April 2020) amidst a high burden of disease.
When announcing the aforesaid There is also the potential to lower costs
relaxations, the HPCSA cautioned that the and improve patient outcomes, particularly
revised provisions on the use of telehealth in under-resourced areas.
are only applicable during the COVID-19
pandemic and indicated it would make
3 | HEALTHCARE & PHARMACEUTICALS ALERT 17 May 2021HEALTHCARE &
PHARMACEUTICALS
Telemedicine: Band-aid or
long-term solution?...continued
Challenges Regarding telemedicine across country
borders, the 2014 Guidelines provide
Telemedicine is not without its risks
Implementing the and challenges.
that practitioners serving South African
patients must be registered with the
lessons learnt requires equivalent regulatory bodies in their
Most obviously of concern are inaccurate
the HPCSA’s stewardship clinical diagnoses in a virtual world, for original countries, as well as with the
in reimagining the example, if patients are unable to correctly HPCSA. This limits the potential for
expansion of telemedicine describe their symptoms, particularly South Africa to obtain exposure to
where there are language barriers, international expertise, particularly for rural
regulation in a manner and there is no physical examination. communities. However, in a subsequent
that responsibly These challenges are less prevalent media statement dated 9 March 2020, the
manages patient risks for certain specialities, such as mental HPCSA makes temporary allowance for
healthcare practitioners registered outside
without foregoing the health consultations.
of South Africa to practice cross-border
potential benefits. Another considerable obstacle is the
telemedicine as long as they are registered
ownership and transfer of patient data, in
with an equivalent professional body in
the light of the absence of an implemented
the country in which they are based. It is
system for a single electronic interoperable
hoped that this amendment can remain
health record. For example, the 2014
post COVID-19, for appropriate use, so
Guidelines require informed consent for
that South Africa can continue to leverage
the use of telemedicine technologies to be
opportunities from international health
obtained in writing from the patient and
human resources.
a witness, that a duplicate of this consent
form be kept as part of the patient record From a pragmatic perspective, South
and a copy be shared with the patient. This Africa’s electricity load shedding epidemic
has been criticised as being impractical, and the high costs of data may present
especially, if the patient is in a remote connectivity challenges. However, this
location, is illiterate, or incapacitated does not mean that telemedicine in and
and urgent advice is required. However, of itself is a dead-end, but rather that
hanging in the balance are the rights eradicating total inequality in healthcare
of patients to informed consent and delivery will be unlikely.
privacy, as well as the requirement for
Converting the band aid into a
POPI compliance.
long-term solution
Reimbursement models are an important
Implementing the lessons learnt
factor in healthcare worker uptake of
requires the HPCSA’s stewardship in
telemedicine solutions. It is understood
reimagining the expansion of telemedicine
that telemedicine consultations are
regulation in a manner that responsibly
broadly still reimbursed at lower rates than
manages patient risks without foregoing
face-to-face consultations. A delicate
the potential benefits. Stakeholder
balance must still be found between
involvement and buy-in through the
reimbursing healthcare workers fairly
participation of patients, healthcare
for time spent in delivering high quality
professionals and providers, funders,
telemedicine services versus losing
technology providers, and the Department
potential cost efficiencies.
of Health, will be critical.
Susan Meyer and Simone Nel
4 | HEALTHCARE & PHARMACEUTICALS ALERT 17 May 2021OUR TEAM
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